GLYCOPEPTIDE SUSCEPTIBILITY AMONG STAPHYLOCOCCI AND ENTEROCOCCI ISOLATES FROM SULAIMANI HEALTH LABORATORIES

Background Glycopeptide antibiotics are bactericidal agents that inhibit late stage bacterial cell wall peptidoglycan synthesis in Gram-positive bacteria. They are used for multiresistant Gram-positive cocci infection such as staphylococci and enterococci. Objectives  To determine glycopeptide susceptibility among staphylococci and enterococci isolates from Sulaimani city health laboratories and find combined methicillin and vancomycin resistance among S. aureus isolates. Materials and Methods Isolates of staphylococci and enterococci were collected from different hospital laboratories and community health laboratories in Sulaimani city. Staphylococci were differentiated based on coagulase test while enterococci species were determined using Vitek 2 ®automated system. Antimicrobial susceptibility test was preformed according to the Bauer-Kirby disk diffusion method using vancomycin, teicoplanin, amoxicillin-clavulanate, cefoxitin, methicillin, erythromycin, amikacin, gentamicin and netilmicin disks. The susceptibility was determined according to the Performance Standards for Antimicrobial Disk Susceptibility Tests. Results A total of 207 isolates of staphylococci and enterococci were collected from six hospital laboratories and two community health laboratories in Sulaimani city. The isolates were 146 Staphylococcus aureus, 36 coagulase-negative staphylococci (CoNS) and 25 enterococci isolates. The isolates were from inpatients 182 (87.9%), the other 25 (12.1%) were from outpatients submitting their specimens to community health laboratories. Resistance to vancomycin was detected in one isolate of each S. aureus (0.7%), CoNS (2.8%) andenterococci species (4%). For teicoplanin, one S. aureus isolate showed intermediate response (0.7) and two isolates (1.4%) were resistant. One isolate of each CoNS (2.8%) and enterococci spp. (4%) was resistant to teicoplanin. One MRSA isolate (1.25%) was resistant to vancomycin and combined resistance to both vancomycin and teicoplanin was detected in three isolates.  Conclusion Glycopeptide resistance was reported in staphylococci and enterococci but was uncommon. The reported resistance advises regular observation and monitoring the antibiotic susceptibility and strict antibiotic policy. Glycopeptide alternative still can be used in treatment of some Gram-positive infections, this may delay the emergence and spread of glycopeptide resistance.